There are many ways to create a change plan and it is exciting when a client is very motivated to make this happen. However, it is also important to make sure the plan is reasonable and there are possible sub-goals along the way. We discussed this in an earlier blog since a client may have a strong desire or need for change to occur, but the key is to make sure the client is successful and not taking on too much.
We also know that change is more likely to occur gradually, so we want to make sure the client doesn’t become discouraged if they are not progressing fast enough towards their goal. One way to work with an extremely motivated client is to perhaps have an “ultimate goal” and the “steps” needing to be taken to get there. This can be very helpful to keep the client committed to their plan, especially if it is early in the process.
Below are a few examples from Miller and Rollnick of what “taking a step” towards an “ultimate” goal might look like in planning. The “ultimate” goals are quite specific, but they are also quite ambitious. Therefore, breaking the goals down into smaller, more realistic, and gradual steps can keep the motivation and commitment high:
- Taking a step
- “I will fill the prescription today and start taking this medication”
- Ultimate goal
- “I will keep my Hba1c [blood glucose] level under 7.0.”
- Taking a step
- “I intend to lose 5 pounds this month”
- Ultimate goal
- “I will lose 50 pounds”
- Taking a step
- “I plan to not drink today”
- Ultimate goal
- “I will never drink again”
This can be a great opportunity to talk with a client about their understanding of behavior change and how it typically happens. It can be important to acknowledge their excitement and motivation and explore the challenges of being able to sustain a change over time. The approach of “taking a step” allows for the plan to be evaluated along the way and making any adjustments needed either to the steps or the “ultimate goal.”
This process is to help support the client in being successful with their plan, especially if it is an ambitious one. It also can provide an opportunity for education while supporting a gradual process of change. In next month’s blog, we will continue looking at how best to strengthen commitment. I hope everyone is doing as well as possible and you have opportunities to use and practice motivational interviewing.
For more information about Motivational Interviewing or related services, contact Steve Bradley-Bull, LCMHC, by phone, (919) 812-9203, or by email, steve_bradley-bull@med.unc.edu
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